HEALTH INFORMATION

Includes causes and symptoms of heart disease. Looks at cholesterol, hypertension, and risk of heart attack. Covers diet, physical activity, and treatment with medicines, angioplasty, and bypass surgery. Includes how to help prevent heart disease.

Includes causes and symptoms of heart disease. Looks at cholesterol, hypertension, and risk of heart attack. Covers diet, physical activity, and treatment with medicines, angioplasty, and bypass surgery. Includes how to help prevent heart disease.

Coronary Artery Disease

Topic Overview

What is coronary artery disease?

Coronary artery disease is the most common type of heart disease. It's also the
number one killer of both men and women in the United States.

When you have it, your heart muscle doesn't get enough blood. This can lead to serious problems,
including
heart attack.

It
can be a shock to find out that you have coronary artery disease. Many people
only find out when they have a heart attack. Whether or not you have had a
heart attack, there are many things you can do to slow coronary artery disease
and reduce your risk of future problems.

What causes coronary artery disease?

Coronary artery disease is
caused by hardening of the arteries, or
atherosclerosis. This means that fatty deposits called plaque (say "plak") build up inside the arteries. Arteries are the blood vessels that carry
oxygen-rich blood throughout your body.

Atherosclerosis can affect any
arteries in the body. When it occurs in the ones that supply blood to the
heart (the coronary arteries), it is called coronary artery disease.

When plaque builds
up in the coronary arteries, the heart may not get the blood it needs to work
well. Over time, this can weaken or damage the heart. If a plaque tears, the
body tries to fix the tear by forming a blood clot around it. The clot can
block blood flow to the heart and cause a heart attack.

What are the symptoms?

Symptoms can happen when the heart is working harder and needs more oxygen, such as during
exercise. Symptoms include:

Angina (say "ANN-juh-nuh" or "ann-JY-nuh"), which most often is chest pain or discomfort or a strange feeling in the chest.

Shortness of breath.

Heart attack. A heart attack is sometimes the first sign of
coronary artery disease.

Less common symptoms include a fast heartbeat, feeling sick
to your stomach, and increased sweating. Some people don't have any symptoms.
In rare cases, a person can have a "silent" heart attack, without
symptoms.

How is coronary artery disease diagnosed?

Your doctor will do a physical exam and ask questions about your past health and
your risk factors. Risk factors are things that increase the chance that you
will have coronary artery disease.

Some common risk factors are
being older than 65; smoking; having high cholesterol, high blood pressure, or
diabetes; and having heart disease in your family.

If your doctor thinks that you have coronary artery disease, you may have
tests to check how well your heart is working. These tests include an electrocardiogram (EKG or ECG), a chest X-ray, an exercise electrocardiogram, and blood tests. You may also have a coronary angiogram to check blood flow to the heart.

How is it treated?

Lifestyle changes include quitting smoking (if you smoke), eating heart-healthy foods, getting regular exercise, staying at a healthy weight, lowing your stress level, and limiting how much alcohol you drink. A cardiac rehab program can help you make these changes.

Medicines can help you lower high cholesterol and high blood pressure, manage angina, and lower your risk of having a blood clot.

Cause

Coronary artery disease is
caused by hardening of the arteries, or
atherosclerosis. This means that fatty deposits called plaque
build up inside the arteries. Arteries are the blood vessels that carry
oxygen-rich blood throughout your body.

Atherosclerosis can affect any
arteries in the body. When it occurs in the arteries that supply blood to the
heart (the coronary arteries), it is called coronary artery disease.

When plaque builds
up in the coronary arteries, the heart may not get the blood that it needs to work
well. This is called ischemia (say "is-KEE-mee-uh"). Ischemia can cause symptoms such as chest pain or pressure. Over time, ischemia can weaken or damage the heart. Sometimes the plaque buildup does not limit blood flow.

If the plaque breaks apart, it can cause a heart attack. A tear or rupture in the plaque tells the body to repair the injured artery lining, much as the body might heal a cut on the skin. A blood clot forms to seal the area. The blood clot can completely block blood flow to the heart muscle and cause a heart attack.

Symptoms

The most common symptoms of
coronary artery disease are angina (say "ANN-juh-nuh" or "ann-JY-nuh") and shortness of breath when exercising or doing other vigorous activity. Women are somewhat more likely than men to have other symptoms like nausea and back or jaw pain.

Angina

Angina symptoms include chest pain or pressure or a strange feeling in the chest. This feeling can be in areas other than the chest, such as in the neck or jaw. Angina can be stable or unstable.

Stable angina has a typical pattern. You can likely predict when it will happen. It happens
when your heart is working harder and needs more oxygen, such as during exercise. Symptoms go
away when you rest or take nitroglycerin.

Unstable angina is a change in your usual pattern of
stable angina. It is a warning sign that a heart attack may soon occur. It is an
emergency.

Silent ischemia

Some people don't have any symptoms. This is called "silent ischemia." In rare cases, you can even have a "silent heart attack," a heart attack without symptoms.

What Increases Your Risk

Things that increase your risk of coronary artery disease are the things that lead to a problem called atherosclerosis, or hardening of the arteries. Atherosclerosis is the starting point for coronary artery disease, peripheral arterial disease, heart attack, and stroke.

Your doctor can help you find out your risk of heart disease, heart attack, and stroke. Knowing your risk is just the beginning for you and your doctor. Knowing your risk can help you and your doctor talk about whether you need to lower your risk. Together, you can decide what treatment is best for you.

Things that increase your risk include:

High cholesterol.

High blood pressure.

Diabetes.

Smoking.

A family history of early heart disease. Early heart disease means you have a male family member who was diagnosed before age 55 or a female family member who was diagnosed before age 65.

Your age, sex, and race can also raise your risk. For example, your risk increases as you get older.

When to Call a Doctor

Do not wait if you think you are having a heart attack. Some people aren't sure whether they're having one, or they don't want to bother others, so they wait. But getting help fast can save your life.

Call 911 or other emergency services immediately if you have symptoms of a heart attack or are with someone who has symptoms. Symptoms may include:

Chest pain or pressure, or a strange feeling in the chest.

Sweating.

Shortness of breath.

Nausea or vomiting.

Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.

Lightheadedness or sudden weakness.

A fast or irregular heartbeat.

After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself. By taking an ambulance, you may be able to start treatment before you arrive at the hospital.

Nitroglycerin. If you typically use nitroglycerin to relieve angina and if one dose of nitroglycerin has not relieved your symptoms
within 5 minutes, call 911. Do not wait to call for help.

Who to see

To see if you are at risk for heart
disease, have symptoms of heart disease, or need long-term care
for existing heart disease, see your
family doctor or
internist. For diagnosis of coronary artery disease,
you may see a
cardiologist. For ongoing care of stable angina, you
will likely see your family doctor or an internist. For angioplasty or surgery,
you will be referred to an interventional cardiologist or cardiovascular surgeon.

Exams and Tests

Your doctor will do a physical exam and a number of tests to find out your risk for coronary artery disease and to diagnose it.

Sometimes doctors schedule heart tests because they think that's what patients expect. But some heart tests may not be needed. If your doctor recommends a test, ask what it is for and why you need it. See the topic Heart Tests: When Do You Need Them?

To diagnose coronary artery disease

If
your doctor thinks you may have heart disease, you will need some tests to make
sure. Most often, the first tests include:

It's also important to manage any health problems you have. If you have high blood pressure, high cholesterol, or diabetes, be sure you're doing everything you can to keep these conditions under control.

"I've had to work at keeping my
weight under control, and that has really helped my cholesterol. When you have
heart disease, you learn to eat better for the rest of your life. And if you
don't, you're asking for trouble."—Alan

Procedures

If your angina symptoms get worse even though you are
taking medicines, you may think about having a procedure to improve blood flow to your heart.
These include
angioplasty with or without stenting and
bypass surgery.

Palliative care

Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life—not just in your body but also in your mind and spirit.

You can have this care along with treatment to cure your illness. You can also have it if treatment to cure your illness no longer seems like a good choice.

Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.

End-of-life care

If your heart disease is advanced, it may shorten your life. So you
need to decide what kind of care you want at the end of your
life.

It can be hard to have talks with your
doctor and family about the end of your life. But making these decisions now
may bring you and your family peace of mind. Your family won't have to wonder
what you want. And you can spend your time focusing on your
relationships.

You will need to decide if you want
life-support measures if your health gets very bad. An
advance directive is a legal document that
tells doctors how to care for you at the end of your life.
You also can say where you want to have care. And you can name
someone who can make sure your wishes are followed.

Prevention

You can help prevent coronary artery disease by taking steps toward a heart-healthy lifestyle. A heart-healthy lifestyle can also help you reduce risk factors such as
high cholesterol and
high blood pressure.

Use lifestyle changes

Quit smoking. Avoid secondhand smoke too. Quitting smoking may be the best thing you can do to
prevent heart disease.

Exercise. There are lots of ways that
exercise boosts your heart health. It can improve cholesterol and blood pressure. It
can also help you reach a healthy weight. Talk to your doctor before
starting an exercise program to make sure that it's safe for you.

Stay at a healthy weight. Being active and eating healthy foods can help you stay at a healthy weight or lose weight if you need to.

Manage other health problems

Manage other health problems that raise your risk for a heart attack. These include diabetes, high blood pressure, and high cholesterol. A heart-healthy lifestyle can help you manage these problems. But you may also need to take medicine.

Ask your doctor about aspirin

If you're already at risk
for heart disease, taking daily
aspirin may reduce your chances of having a stroke or
a heart attack. That's because a daily aspirin lowers your risk of getting
blood clots. Blood clots can lead to a heart attack in people with heart
disease. Clots can also cause heart attacks in people who have other problems
that can lead to heart disease, such as
diabetes,
high blood pressure, and
high cholesterol.

Taking aspirin has
some risks. Talk with your doctor before starting aspirin treatment.

Reduce stress

Stress can hurt your heart.
Keep stress low by talking about your problems and feelings, rather than
keeping your feelings hidden. Try different ways to reduce stress, such as exercise, deep breathing, meditation, or
yoga.

What Happens

Coronary artery disease most often begins when the inside walls of the coronary arteries are damaged because of another health problem, such as high cholesterol, high blood pressure, diabetes, or smoking. This damage can lead to atherosclerosis, or hardening of the arteries. This means that plaque, made of fats and other substances, builds up in the coronary arteries.

If your heart disease gets worse, your arteries will narrow, and less
blood will flow to your heart. You may start to have angina symptoms, such as chest pain or discomfort when
you exercise or feel stressed. This is called
stable angina.

In some cases,
sudden and serious problems can happen. Some types of plaque are unstable. They can suddenly tear and cause blood clots to
form. These clots block blood flow to your heart, causing a heart attack or
unstable angina.

Complications of heart disease

Over time, you may have other health problems
caused by coronary artery disease. Low blood flow can make it harder for your
heart to pump. This can lead to
heart failure or
atrial fibrillation. Atrial fibrillation increases the
risk of stroke.

Living With Heart Disease

A diagnosis of
coronary artery disease can be hard to accept and
understand. If you don't have symptoms, it may be especially hard to recognize
that heart disease is serious and can lead to other health problems.

It's important to talk with your doctor to learn about the disease and
what you can do to help manage it and keep it from getting worse.

Lifestyle changes

Quit smoking, and avoid secondhand smoke. Quitting smoking is the best thing you can do to reduce your
risk of future problems. When you quit, you quickly lower your risk of a heart attack.

Exercise. Start an exercise program (if your doctor says it's safe). Try walking, swimming, biking, or jogging for at least 30 minutes on most, if not all, days of the week. Any activity you enjoy will work, as long as it gets your heart rate up.

Eat a heart-healthy diet. This can help you keep your disease from getting
worse. A chart(What is a PDF document?) that compares heart-healthy diets can help you see what foods are suggested in each plan. Heart-healthy foods include fruits, vegetables, high-fiber foods, fish, and foods low in sodium, saturated fat, trans fat, and cholesterol.

Your doctor may suggest that you attend a cardiac rehabilitation (rehab) program. In cardiac rehab, you will get education and support that help you build new, healthy
habits, such as eating right and getting more exercise.

Get help for depression

Depression and heart disease are linked. People with heart disease are more likely to get depressed. And if a person has both depression and heart disease, he or she may not stay as healthy as possible. This can make depression and heart disease worse.

Manage other health problems

To reduce your risk of heart attack or stroke, you will need to
control other health problems you may have. These problems include diabetes, high cholesterol, and high blood pressure.

Other steps to stay healthy

Find emotional support. Think about joining a heart disease support group. Ask your doctor about the types of support that are available where you live. Meeting other people with the same problems can help you know you're not alone. Your family and friends can also give you support.

Drink alcohol in moderation, if you drink. This means having 1 drink a day for women or 2 drinks a day for men.

Manage stress and anger. Stress and anger can also hurt your heart.
They might make your symptoms worse. Try different ways to reduce stress, such as exercise, deep breathing, meditation, or
yoga.

Seek help for sleep problems.Sleep apnea is a common problem in people who have heart disease.

Have sex when you're ready. If you are worried about sex and your heart, talk with your doctor. Your doctor can help you know if your heart is healthy enough for sex.

Medications

Medicines are an important part of your treatment. Using them correctly can lower your risk of having a heart attack or dying from coronary artery disease.

Medicine to prevent blood clots from forming and causing a heart attack

Aspirin, ibuprofen, and naproxen
are all nonsteroidal anti-inflammatory drugs (NSAIDs) and can relieve pain and
inflammation. But only aspirin will reduce your risk for heart attack or
stroke. Don't substitute ibuprofen or naproxen for
low-dose aspirin therapy. If you need to take an NSAID
for a long time, talk with your doctor to see if it is safe for you.

Medicine to manage angina symptoms

If you take nitrates

Do not use erection-enhancing medicines such as sildenafil
(Viagra), tadalafil (Cialis), or vardenafil (Levitra) if you take nitroglycerin
or other nitrates for angina. Combined, these two drugs can cause a serious
drop in blood pressure. Talk to your doctor. There are
other medicines that may work instead to ease your angina.

Help taking your medicines

Medicine is a powerful tool to help you manage your heart disease. To get the most of your medicines, take them as prescribed. This may be hard because of how many you have to take and their cost. You may also worry about side effects.

You may have regular blood tests to monitor how the medicine is working in your body. Your doctor will likely let you know when you need to have the tests.

Surgery

Sometimes coronary artery bypass graft surgery is needed to improve blood flow to the heart. During this surgery, a
doctor connects (grafts) a healthy artery or vein from another part of your
body to the narrowed or blocked coronary artery. The grafted artery goes around (bypasses)
the narrowed or blocked part of the artery. The bypass provides a new pathway for blood to
your heart.

If you have surgery, you'll still need to make changes in the way you eat and how much you
exercise. These changes, along with not smoking, will give you the best chance
of living a longer, healthier life. A cardiac rehabilitation program can help you make these healthy changes.

Angioplasty

Angioplasty is a procedure that widens the coronary artery to improve blood flow to the heart. It is done using a thin,
soft tube called a catheter, which is inserted in your artery.

Angioplasty is not surgery. It doesn't use
large cuts (incisions) or require anesthesia to make you sleep.

Most of the time, stents are placed during
angioplasty. The stent keeps the artery open. When stents are used, there is a
smaller chance that the artery will become narrow again.

Atherectomy might be done during angioplasty. Atherectomy is done to shave away and maybe remove plaque in a narrowed artery. It is only done in certain cases.

If you decide to have angioplasty, you'll still need
to make changes in the way you eat and how much you exercise. These changes,
along with not smoking, will give you the best chance of living a longer,
healthier life. A cardiac rehabilitation program can help you make these healthy changes.

Related Information

References

Other Works Consulted

Budoff M, et al. (2006). Assessment of coronary artery
disease by cardiac computed tomography: A scientific statement from the
American Heart Association Committee on Cardiovascular Imaging and
Intervention, Council on Cardiovascular Radiology and Intervention, and
Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation, 114(16): 1761–1791.

Drozda J Jr, et al. (2011). ACCF/AHA/AMA PCPI 2011 Performance measures for adults with coronary artery disease and hypertension: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures and the American Medical Association Physician Consortium for Performance Improvement. Journal of the American College of Cardiology, 58(3): 316–336.

Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents (2011). Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: Summary report. Pediatrics, 128(Suppl 5): S213–S256.

Fihn SD, et al. (2012). ACCF/AHA/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 126(25): e354–e471.

Goff DC Jr, et al. (2013). 2013 ACC/AHA guideline on the assessment of cardiovascular risk: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online November 12, 2013. DOI: 10.1161/01.cir.0000437741.48606.98. Accessed November 22, 2013.

Goldstein LB, et al. (2010). Guidelines for the primary prevention of stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. Published online December 2, 2010 (doi: 10.1161/STR.0b013e3181fcb238). Also available online: http://stroke.ahajournals.org/content/42/2/517.full.

Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.

Stone NJ, et al. (2013). 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, published online November 12, 2013. DOI: 10.1161/01.cir.0000437738.63853.7a. Accessed November 18, 2013.

Taylor AJ, et al. (2010). ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 – Appropriate use criteria for cardiac computed tomography: A Report of the American
College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. Journal of the American College of Cardiology, 56(22): 1864–1894.

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